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Cerebrovascular Complications of Neurocysticercosis: Clinical and Neuroimaging Spectrum

Cerebrovascular Complications of Neurocysticercosis: Clinical and Neuroimaging Spectrum Abstract Objective: To describe the clinical and neuroimaging spectrum of cerebral Cysticercus arteritis to clarify the mechanisms of a stroke that is associated with neurocysticercosis. Design: Case series. Setting: Tertiary care center. Patients: Sixty-five patients with strokes that were associated with neurocysticercosis. Based on the extension of cysticercosis, the study group was divided into patients with focal or diffuse cysticercal disease. Patients with focal affection were subdivided into those with small- and large-vessel angiitis. Measures: For each group, stroke syndromes, mode of onset, associated neurologic syndromes, neuroimaging features of cysticercosis and cerebral infarcts, angiographic and cerebrospinal fluid findings, and outcome were analyzed. Results: Thirty-five patients had focal cysticercosis (13 with small- and 22 with large-vessel angiitis), and 30 had diffuse disease with either small- or large-vessel involvement. A high frequency of subarachnoidal cysts was found, neighboring the ischemic area. Patients with focal cysticercosis had a vascular onset in 80% compared with 20% in those with diffuse cysticercosis (P<.001). Distinctive findings in diffuse cysticercosis were hydrocephalus (80%), multiple cerebral infarcts (64%), and mental disorders (43%) (P<.001). There was a close parallelism between the type of cysticercosis and the degree of cerebrospinal fluid inflammatory changes, reflecting in the outcome. Death or incapacitating sequelae were associated with diffuse cysticercosis, and total recovery was common in patients with focal disease and small-vessel angiitis, whereas intermediate morbimortality occurred with focal cysticercosis and large-vessel vasculitis. Conclusion: Based on the distribution of cysticercal disease and the severity of concomitant chronic arachnoiditis, it is possible to identify a wide spectrum of cerebrovascular involvement caused by neurocysticercosis. References 1. Centers for Disease Control and Prevention. Neurocysticercosis: update: International Task Force for Disease Eradication . MMWR Morb Mortal Wkly Rep . 1992;41:697-698. 2. Wiederholt WC, Grisola JS. Cysticercosis: an old scourage revisited . Arch Neurol . 1982:39:533.Crossref 3. Scharf D. Neurocysticercosis: two hundred thirty-eight cases from a California hospital . Arch Neurol . 1988;45:777-780.Crossref 4. Shandera WX, White C, Chen JC, Díaz P, Armstrong R. Neurocysticercosis in Houston, Texas: a report of 112 cases . Medicine (Baltimore) . 1994;73:37-52.Crossref 5. Barinagarrementeria F, Del Brutto OH. Lacunar syndrome due to neurocysticercosis . Arch Neurol . 1989;46:415-417.Crossref 6. Del Brutto OH. Cysticercosis and cerebrovascular disease: a review . J Neurol Neurosurg Psychiatry . 1992;55:252-254.Crossref 7. Alarcón F, Hidalgo F, Moncayo J, Viñan I, Dueñas G. Cerebral cysticercosis and stroke . Stroke . 1992;23:224-228.Crossref 8. Barinagarrementeria F, Cantú C. Neurocysticercosis as a cause of stroke . Stroke . 1992;23:1180-1181.Crossref 9. Alarcón F, Vanormelingen K, Moncayo J, Viñan I. Cerebral cysticercosis as a risk factor for stroke in young and middle-age people . Stroke . 1992;23:1563-1565.Crossref 10. Monteiro L, Almeida-Pinto J, Leite I, Xavier J, Correia M. Cerebral Cysticercus arteritis: five angiographic cases . Cerebrovasc Dis . 1994;4:125-133.Crossref 11. McCormick GF, Giannota S, Zee CS, Fisher M. Carotid occlusion in cysticercosis . Neurology . 1983;33:1078-1080.Crossref 12. Barinagarrementeria F, Del Brutto OH, Otero E. Ataxic hemiparesis from cysticercosis . Arch Neurol . 1988;45:246.Crossref 13. Rodriguez-Carbajal J, Del Brutto OH, Penagos P, Huebe J, Escobar A. Occlusion of the middle cerebral artery due to cysticercotic angiitis . Stroke . 1989; 20:1095-1098.Crossref 14. terPenning B, Litchman CD, Heier L. Bilateral middle cerebral artery occlusions in neurocysticercosis . Stroke . 1992;23:280-283.Crossref 15. Levy AS, Lilleher KO, Rubenstein D, Stears JC. Subarachnoid neurocysticercosis with occlusion of the major intracranial arteries: case report . Neurosurgery . 1995;36:183-188.Crossref 16. Sotelo J, Guerrero V, Rubio F. Neurocysticercosis: a new classification based on active and inactive forms: a study of 753 cases . Arch Intern Med . 1985; 145:442-445.Crossref 17. Hatano S. Experience from a multicentre stroke registry: a preliminary report . Bull World Health Organ . 1976;54:541-553. 18. Chodosh EH, Foulkes MA, Kase CS, et al. Silent stroke in NINCDS stroke data bank . Neurology . 1988;38:1674-1679.Crossref 19. National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular disease Ill . Stroke . 1990;21:637-676.Crossref 20. Ginsberg LE. Contrast enhancement in meningeal and extra-axial disease . Neuroimaging Clin N Am . 1994;4:133-152. 21. Leeds NE, Goldberg HI. Angiographic manifestations in cerebral inflammatory disease . Radiology . 1971;98:595-604.Crossref 22. Ferris EJ, Levine HL. Cerebral arteritis: classification . Radiology . 1973;109:327-341.Crossref 23. Escobar A, Nieto D. Parasitic diseases . In: Minckler J, ed. Pathology of the Nervous System . New York, NY: McGraw-Hill International Book Co; 1972;3:2503-2521. 24. Barinagarrementeria F, Del Brutto OH. Neurocysticercosis and pure motor hemiparesis . Stroke . 1988;19:1156-1158.Crossref 25. Torrealba G, del Villar S, Tagle P, Arriagada P, Kase CS. Cysticercosis of the central nervous system: clinical and therapeutic considerations . J Neurol Neurosurg Psychiatry . 1984;47:784-790.Crossref 26. Barinagarrementeria F. Non-vascular etiology of lacunar syndromes . J Neurol Neurosurg Psychiatry . 1990:53:1111.Crossref 27. Portenog RK, Abissi CJ, Lipton RB, et al. Headache in acute cerebrovascular disease . Stroke . 1985;15:1009-1012.Crossref 28. Vesttergaard K, Andersen G, Nielsen Ml, Jensen TS. Headache in stroke . Stroke . 1993;24:1621-1624.Crossref 29. Del Brutto OH, Garcia E, Talamas O, Sotelo J. Sex-related severity of inflammation in parenchymal brain cysticercosis . Arch Intern Med . 1988;148:544-546.Crossref 30. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis: a long-term follow-up review of 92 cases . J Neurosurg . 1987;66:686-689.Crossref 31. Del Brutto OH, Sotelo J, Roman GC. Therapy for neurocysticercosis: a reappraisal . Clin Infect Dis . 1993;17:730-735.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Cerebrovascular Complications of Neurocysticercosis: Clinical and Neuroimaging Spectrum

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1996.00550030039021
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Abstract

Abstract Objective: To describe the clinical and neuroimaging spectrum of cerebral Cysticercus arteritis to clarify the mechanisms of a stroke that is associated with neurocysticercosis. Design: Case series. Setting: Tertiary care center. Patients: Sixty-five patients with strokes that were associated with neurocysticercosis. Based on the extension of cysticercosis, the study group was divided into patients with focal or diffuse cysticercal disease. Patients with focal affection were subdivided into those with small- and large-vessel angiitis. Measures: For each group, stroke syndromes, mode of onset, associated neurologic syndromes, neuroimaging features of cysticercosis and cerebral infarcts, angiographic and cerebrospinal fluid findings, and outcome were analyzed. Results: Thirty-five patients had focal cysticercosis (13 with small- and 22 with large-vessel angiitis), and 30 had diffuse disease with either small- or large-vessel involvement. A high frequency of subarachnoidal cysts was found, neighboring the ischemic area. Patients with focal cysticercosis had a vascular onset in 80% compared with 20% in those with diffuse cysticercosis (P<.001). Distinctive findings in diffuse cysticercosis were hydrocephalus (80%), multiple cerebral infarcts (64%), and mental disorders (43%) (P<.001). There was a close parallelism between the type of cysticercosis and the degree of cerebrospinal fluid inflammatory changes, reflecting in the outcome. Death or incapacitating sequelae were associated with diffuse cysticercosis, and total recovery was common in patients with focal disease and small-vessel angiitis, whereas intermediate morbimortality occurred with focal cysticercosis and large-vessel vasculitis. Conclusion: Based on the distribution of cysticercal disease and the severity of concomitant chronic arachnoiditis, it is possible to identify a wide spectrum of cerebrovascular involvement caused by neurocysticercosis. References 1. Centers for Disease Control and Prevention. Neurocysticercosis: update: International Task Force for Disease Eradication . MMWR Morb Mortal Wkly Rep . 1992;41:697-698. 2. Wiederholt WC, Grisola JS. Cysticercosis: an old scourage revisited . Arch Neurol . 1982:39:533.Crossref 3. Scharf D. Neurocysticercosis: two hundred thirty-eight cases from a California hospital . Arch Neurol . 1988;45:777-780.Crossref 4. Shandera WX, White C, Chen JC, Díaz P, Armstrong R. Neurocysticercosis in Houston, Texas: a report of 112 cases . Medicine (Baltimore) . 1994;73:37-52.Crossref 5. Barinagarrementeria F, Del Brutto OH. Lacunar syndrome due to neurocysticercosis . Arch Neurol . 1989;46:415-417.Crossref 6. Del Brutto OH. Cysticercosis and cerebrovascular disease: a review . J Neurol Neurosurg Psychiatry . 1992;55:252-254.Crossref 7. Alarcón F, Hidalgo F, Moncayo J, Viñan I, Dueñas G. Cerebral cysticercosis and stroke . Stroke . 1992;23:224-228.Crossref 8. Barinagarrementeria F, Cantú C. Neurocysticercosis as a cause of stroke . Stroke . 1992;23:1180-1181.Crossref 9. Alarcón F, Vanormelingen K, Moncayo J, Viñan I. Cerebral cysticercosis as a risk factor for stroke in young and middle-age people . Stroke . 1992;23:1563-1565.Crossref 10. Monteiro L, Almeida-Pinto J, Leite I, Xavier J, Correia M. Cerebral Cysticercus arteritis: five angiographic cases . Cerebrovasc Dis . 1994;4:125-133.Crossref 11. McCormick GF, Giannota S, Zee CS, Fisher M. Carotid occlusion in cysticercosis . Neurology . 1983;33:1078-1080.Crossref 12. Barinagarrementeria F, Del Brutto OH, Otero E. Ataxic hemiparesis from cysticercosis . Arch Neurol . 1988;45:246.Crossref 13. Rodriguez-Carbajal J, Del Brutto OH, Penagos P, Huebe J, Escobar A. Occlusion of the middle cerebral artery due to cysticercotic angiitis . Stroke . 1989; 20:1095-1098.Crossref 14. terPenning B, Litchman CD, Heier L. Bilateral middle cerebral artery occlusions in neurocysticercosis . Stroke . 1992;23:280-283.Crossref 15. Levy AS, Lilleher KO, Rubenstein D, Stears JC. Subarachnoid neurocysticercosis with occlusion of the major intracranial arteries: case report . Neurosurgery . 1995;36:183-188.Crossref 16. Sotelo J, Guerrero V, Rubio F. Neurocysticercosis: a new classification based on active and inactive forms: a study of 753 cases . Arch Intern Med . 1985; 145:442-445.Crossref 17. Hatano S. Experience from a multicentre stroke registry: a preliminary report . Bull World Health Organ . 1976;54:541-553. 18. Chodosh EH, Foulkes MA, Kase CS, et al. Silent stroke in NINCDS stroke data bank . Neurology . 1988;38:1674-1679.Crossref 19. National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular disease Ill . Stroke . 1990;21:637-676.Crossref 20. Ginsberg LE. Contrast enhancement in meningeal and extra-axial disease . Neuroimaging Clin N Am . 1994;4:133-152. 21. Leeds NE, Goldberg HI. Angiographic manifestations in cerebral inflammatory disease . Radiology . 1971;98:595-604.Crossref 22. Ferris EJ, Levine HL. Cerebral arteritis: classification . Radiology . 1973;109:327-341.Crossref 23. Escobar A, Nieto D. Parasitic diseases . In: Minckler J, ed. Pathology of the Nervous System . New York, NY: McGraw-Hill International Book Co; 1972;3:2503-2521. 24. Barinagarrementeria F, Del Brutto OH. Neurocysticercosis and pure motor hemiparesis . Stroke . 1988;19:1156-1158.Crossref 25. Torrealba G, del Villar S, Tagle P, Arriagada P, Kase CS. Cysticercosis of the central nervous system: clinical and therapeutic considerations . J Neurol Neurosurg Psychiatry . 1984;47:784-790.Crossref 26. Barinagarrementeria F. Non-vascular etiology of lacunar syndromes . J Neurol Neurosurg Psychiatry . 1990:53:1111.Crossref 27. Portenog RK, Abissi CJ, Lipton RB, et al. Headache in acute cerebrovascular disease . Stroke . 1985;15:1009-1012.Crossref 28. Vesttergaard K, Andersen G, Nielsen Ml, Jensen TS. Headache in stroke . Stroke . 1993;24:1621-1624.Crossref 29. Del Brutto OH, Garcia E, Talamas O, Sotelo J. Sex-related severity of inflammation in parenchymal brain cysticercosis . Arch Intern Med . 1988;148:544-546.Crossref 30. Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis: a long-term follow-up review of 92 cases . J Neurosurg . 1987;66:686-689.Crossref 31. Del Brutto OH, Sotelo J, Roman GC. Therapy for neurocysticercosis: a reappraisal . Clin Infect Dis . 1993;17:730-735.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Mar 1, 1996

References